Taxonomy of an Anesthetic Flashcards
1
Q
What is anesthesia?
A
amnesia & unconsciousness
2
Q
5 components of anesthesia
A
- amnesia
- analgesia
- unconsciousness
- immobility
- areflexia
→attenuation of ANS response to noxious stimulation
3
Q
balanced anesthesia triangle is between (3)
A
amnesia, analgesia, muscle relaxation
4
Q
3 types of anestheisa
A
Monitored anesthesia care (MAC) general anesthesia (inhaled or TIVA) Regional anesthesia - topical or infiltration - peripheral nerve block - plexus block - central neuraxial blocks (spinal vs epidural)
5
Q
managing an anesthetic has 6 steps
A
- preparation
- pre-induction
- induction
- maintenance
- emergence
- post-op
6
Q
types of positioning equipment (7)
A
- head rest
- arm boards/pads
- prone pillow
- axillary roll
- extra pillows/padding
- eye pads/lubricant
- anesthesia circuit extenders
7
Q
Medication label should include:
A
- drug name
- concentration
- date
- time
- initials
8
Q
2 common medication errors
A
- administration of muscle relaxant when reversal was intended
- misidentification of same color label
9
Q
Medication types needed for induction (3)
A
- anxiolytics
- narcotics
- induction agent
10
Q
Emergency drugs to prepare:
GAPEES
A
\+/- Glycopyrrolate Atropine [0.4mg/mL or 1mg/mL] Phenylephrine [100mcg/mL] Ephedrine [5mg/mL] Epinephrine [+/- draw up; in cart] Succinylcholine [20mg/mL (10mL)]
11
Q
Steps prior to surgery (5)
A
- preop visit
- preop orders
- preop note
- consults
- anesthesia care plan
12
Q
Pre-Op visit; 6 steps
A
- identify surgical procedure
- medical history
- physical exan
- assign ASA physical status classification
- develop “care plan” & anesthetic technique
- document informed consent & pre-op note
13
Q
Pre-Op orders
A
- tests as indicated
- NPO
- Any pre-medications [continues/ERAS protocol, insulin?]
- special procedures [start IV, check quick labs; glucose, istat]
14
Q
in the holding area (9 steps)
A
- greet pt & family
- identify pt
- reaffirm surgery & site
- interview & reassess
- airway assessment & planning
- review chart for changes since full interview
- formulate anesthetic plan
- obtain consent
- lines (PIV, invasive monitoring)
15
Q
When choosing the anesthetic basics (3)
A
should be patient specific
- promote stability and + patient outcome
- adapt plan to consider patient and surgical needs such as: anatomical/physical findings, functional status, pt medical & surgical history, surgical considerations
- Plan A, B, C
16
Q
Specific considerations when making an anesthetic plan:
A
- pt current physical condition
- type and site of surgery
- surgical position
- costs (equipment)
- elective or emergent surgery
- NPO status
- patient biases
- surgeon skill level
- anesthetists’ skill & preferences
17
Q
Goals for any pharmacological pre-medications
A
- anxiolysis
- sedation
- analgesia
- amnesia
- antisialagoue effect
- antiemetic
- increase gastric fluid pH
- decrease gastric fluid volume
- allergic prophylaxis
- antimicrobial protection
18
Q
Steps of induction (6)
A
- preoxygenate/denitrogenate with 100% O2
- reconfirm surgery and type of anesthesia
- “sweep” monitors & equipment (*SUCTION)
- administer medications [hypnotic, narcotic, induction agent]
- confirm unconsciousness, apnea, position head, attempt to mask ventilate
- muscle relaxant
19
Q
Rapid sequence induction
A
- patient’s considered full stomach
[violated NPO, pregnancy, trauma, cirrhosis, obesity, GERD, GI pathology] - *SUCTION MUST BE READILY AVAILABLE
- *DO NOT MASK VENTILATE
- cricoid pressure applied as induction agent is administered
- CP maintained until ETT placement confirmation is made
aspiration pneumonitis has high morbidity/mortality
20
Q
Maintenance stage 3 components
A
- inhalation agent
- Intravenous agents [narcotics, benzodiazepine, sedation, muscle relaxant]
- fluids [maintenance, deficit, third space, blood loss]
21
Q
Maintenance phase begins & ends…
A
begins post-induction, ends prior to emergence
- many techniques
1. O2 w/ vol agent
2. +/- N2O
3. Narcotics
4. muscle relaxants
5. TIVA
22
Q
Intraoperative management MAIN POINT
A
**VIGILANCE; evaluate pt’s response to surgery & anesthetic
23
Q
intra-op anticipate…
A
- surgical stimulus, bleeding, medication limits
- fluid management & replacement
- monitor blood loss and replace as necessary
24
Q
AANA Standard #7
A
anesthesia plan implementation & management
25
AANA Standard #5
accurate record keeping
26
Emergence
Reversal; inhalation, agent narcotic, relaxant, sedation → extubation → PACU
27
How to time extubation; know 3 things
1. experience
2. familiarity with surgeon
3. alert for clues
28
for extubation, ensure anesthetics are
discontinued or reversed
29
extubation preparation; ensure patient is placed on _____ & allow pt to ____
appropriate O2 concentrations;
breathe spontaneously
30
before extubation; ____ criteria should be met
extubation
31
after extubation ensure ____ & ____ maintatined
airway & spontaneous ventilation
32
7 reasons for failure to emerge
1. residual NMBD
2. excessive opioid or benzodiazepine
3. intraoperative CVA
4. pre-existing pathophysiological conditions
5. electrolyte abnormalities
6. acidosis
7. hypothermia
33
before transporting to PACU:
- stabilize patient in the OR
- vigilance in monitoring
- transport O2 as appropriate
- safe hand-off to qualified professional / PACU nurse
34
PACU report includes:
1. Pt Hx
2. surgical procedure
3. anesthetic
4. intraoperative course
5. fluid status (EBL; I&O)
35
What's next after transferring patient to PACU?
- recheck machine
- clean anesthesia work station
- set up OR for next case
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